Recently, AACD Member, Dane Barlow, joined the AACD for a webinar titled "COVID-19 and Emergency Cases: PPE and Protocol for an Invisible Enemy." The program included a lively question and answer session regarding PPE and what dentists can do to ensure they can return to work safely. Here are the top questions dentists asked, and the answers that HazMat specialist and lab tech, Dane Barlow, offered.

If a person has an N95 mask on and a great coverage face shield, do they need glasses that seal to the face? Wouldn’t safety glasses and /or loupes replace these and would prescription glasses under this great face shield be enough? I thought you were saying that the eyes only get the infection from droplet form direct contact or hands touching the eye and not aerosolization.  Goggles (seal to the face) would replace the face shield?

Answer: Goggles protect the eyes from being an entry point. Face shields have been proving to be very efficient in the hospitals. Remember all the proper steps we can take to isolate viral loads prior to using the high speed. This is where aerosolization occurs by our actions. At this point, direct exposure to the patient can be dramatically reduced and the face shield option can remain effective.  There is a possibility with just loupes at the right angle and distance you could have contaminate enter the eyes. So this is where EOS device can help as well. Also see this article. 

I have only KN95 respirator masks that I have been able to acquire. I got them from a restauranteur who had contacts in China. They are packaged convincingly and are from one of the manufacturers that are on the list from NIOSH cited by the ADA. I do not have a fit test kit or one available to me so I did a makeshift test at home with one on. These are the only masks I have; what should I do?

Answer: Get an emergency use authorization.

KU 600 Kimberly Sterilization paper has a 98% filter rate, potentially better than N95- can be cut into masks by hand and sewn. This product can be placed in autoclave 20 times. An entire roll is usually under $200. So this is enough masks for an entire team for the whole year. A wire can be placed at the bridge of the nose and sewn into place.

• KC600 Kimguard Sterilization Wrap is tear, flame, lint and abrasion-resistant
• POWERGUARD technology for enhanced microbial barrier protection
• Pre-vacuum steam sterilant penetration
• Bacterial Filtration Efficiency (BFE) from 98.9% to 99.9%

Should we be wearing the same gown when cleaning and disinfecting the room and also should we be changing gowns between patients even if it is a cloth gown?

Answer: Certainly, having an assistant come in to perform the cleaning procedure wearing new PPE reduces risks for cross-contamination.  Education is critical.  Make considerations for the general lack of available PPE. You will want to conserve until the supply increases. Gowns should doff and be contained after each and every patient to prevent cross-contamination.

Are washable lab coats a safe alternative to disposable gowns? We plan on washing them at the end of the day.

Answer: Yes but be prepared to change the outer shell after each patient.  What you can’t see comes with you everywhere you go and everything you touch.

We don’t have face shields or goggles; we do all wear safety glasses or loupes and have surgical masks to wear over N95 masks. Is this ok?

Answer: Try ordering from Carbon3D, or find a dental lab technician who can print shields. Safety glasses can be effective, just consider that this is an area you have to determine risk of exposure and reducing risk is based on the level of PPE you wish to maintain. I would point out the dental field has been a superstar in comparison to other medical fields and that your training according to your vigilance has heretofore been quite successful in preventing cluster exposure and illness. 

To date in the United States, clusters of healthcare workers positive for COVID-19 have been identified in hospital settings and long-term care facilities, but no clusters have yet been reported in dental settings or personnel. The Occupational Safety and Health Administration’s Guidance on Preparing Workplaces for COVID-19 is helpful.

Here is information on reusing masks.

What to do with PPE during hygiene checks?

Answer: Reusable KC 600 masks and use a new one with each patient and change gowns with each patient. Get extra oral vacuum and isolates when possible for cleanings if you believe they will aerosolize in their procedure.

Are there any plastic shields that stand on the floor and bend over the patient?

Answer: No but this could be done with lux and or polycarbonate or just acrylic sheet that it placed onto a mounted floor arm like a mic stand and placed between you and the patient

Is the same long-sleeved lab coat safe to wear all day?

Answer: No please don’t right now until accurate testing is found to work. Then each patient could be tested prior to working on them. Right now there are too many false positives; the tests are picking up antibodies for mild forms of COVID many have had before.

Tell me more about EOS suction.

Answer: Here are some good resources about suction:

• Understanding hepa and efficacy

What about carpeting in the waiting room and hallways? Should they be replaced with cleansable flooring?

Answer: There are arguments in support of carpet as a way of removing pollutants from the feet. Imagine its one giant door mat. Everyone wiping their feet clean as they go. I would, however, be more concerned with using a very good ULPA carpet vacuum and maintain the filters according to manufacturer specifications.  So do some research and consider what you feel is easiest to maintain and clean. Also, see this article. 

What to do if the office has no operatory doors?

Answer: Most do not. Studies have not shown this to currently be an issue, but we may have to start thinking differently about having open room systems in place and go to closed rooms.

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